CONTACT FORM

A PERSON WITH A RARE OR CHRONIC DISEASETHE FAMILY MEMBER, CAREGIVER, OR FRIEND OF SOMEONE WITH A RARE OR CHRONIC DISEASEA HEALTHCARE PROVIDEROTHER

I live: *

IN THE U.S.IN CANADAOUTSIDE THE U.S. AND CANADA

What is the name of the rare or chronic disease you (or the patient) has been diagnosed with? *

Your Name *

First

Last

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Your Email *

Your phone number with area code (optional) *

I need information about: *

SYMPTOMSUP-TO-DATE TREATMENT OPTIONSSPECIALISTS AND/OR TREATMENT CENTERS THAT MAY TREAT THIS DISEASEONLINE OR IN-PERSON SUPPORT GROUPSAVAILABLE CLINICAL TRIALSGROUPS THAT MIGHT HELP PAY FOR MEDICATIONSTHE MOST RELIABLE ONLINE INFO SOURCES FOR THIS ILLNESSTHE MOST HELPFUL MEDICAL JOURNAL ARTICLES FOR YOU AND/OR YOUR DOCTOR(S)QUESTIONS TO ASK YOUR DOCTOR(S) AT THE NEXT APPOINTMENTOTHER (PLEASE DESCRIBE IN COMMENTS / EXTRA INFORMATION BELOW)

Comments / Extra Information *

Please provide only BASIC information or questions in this first contact!
This form is not a secure (HIPAA-compliant) way to communicate, so personal health information given here might be seen by others.

DISCLAIMER: A patient's primary care physician and/or medical specialists are always the best resources for any specific health situation. Joanne Zeis of Patient Pathfinders does not offer medical or legal advice, or diagnose or treat medical problems; she is neither trained nor qualified to offer these services. If you have questions about any of the information provided by Joanne Zeis and/or Patient Pathfinders, please direct those questions to the medical professionals handling the patient's care. ALWAYS ask these medical professionals for guidance before adding or subtracting any treatments (including alternative treatments and any "natural" or herbal preparations) based on any information provided by Joanne Zeis and/or Patient Pathfinders.

Information provided to you by Joanne Zeis and/or Patient Pathfinders will be as complete as possible within the accepted time and budget restrictions, but may not include all of the possible/available medical information, warnings, potential complications, side effects, interactions, or diagnostic, symptomatic, or research/treatment-related options. Any provided specialists' or treatment center names/locations are for informational purposes only; no guarantees are made about their ability to provide satisfactory, complete and/or cost-effective medical care. As in life, there are also no guarantees that the patient will be helped or cured by the researched medications, treatments, specialists, healthcare facilities, or other provided resources. All medical and treatment decisions are solely the responsibility of each client/patient.